Surgery is required when anatomical abnormalities cause or perpetuate chronic prostatitis. Indications include bladder neck sclerosis, suppurating utricular cysts, urethral stenosis, ejaculatory duct obstruction.
In cases of bladder neck sclerosis we remove the excess tissue endoscopically (TURP) or by simple incision (TUIP) in younger patients. TURP can cause retrograde ejaculation in 80% of cases versus 8-10% of cases with TUIP, so it is not recommended in single men of marriageable age.
When suppurating utricular cysts are present we drain the cavity transperitoneally under ultrasound guidance and inject antibiotics and cortisone.
In relapses we make a large transperitoneal incision of the utriculus opening. In cases of urethral stenosis endoscopic removal of the obstruction is mandatory. When infiltrations fail in cases of ejaculatory duct obstruction or impacted stone in the Veru montanum we proceed with transurethral incision.